Dental Definitions Decoded: Annual Plan Maximum

Most dental plans have an annual plan maximum. This doesn’t refer to the most you will pay out of pocket. Instead, this is the maximum dollar amount a dental benefit plan will pay toward the cost of dental care within a specific benefit period (typically January through December).

To further clarify what an annual plan maximum actually is, here’s a quick example:

Let’s say you have a plan with an annual plan maximum of $1,000. Your dentist says you need a crown that will cost $800. According to your plan benefits your share of the cost is 50%, so you’ll pay $400 and your plan will pay the other $400. Because your plan has paid $400 toward your dental expenses so far for the year, subtracting that from the $1,000 plan maximum means the plan will contribute $600 toward any future eligible dental costs for the remaining part of that 12-month period.

Do you have a better understanding of annual plan maximums now? What other dental definitions would you like us to decode?